Rep. Norm Thurston — Voting Record

Bill

Number

S.B. 208 Fourth Substitute (2018GS)

Sponsor

Sen. Vickers, E.

Final action

Governor Signed 3/19/2018

Outcome

Became law — signed by Gov. Gary R. Herbert

Summary

What it does

• This bill:
• defines terms;
• requires a pharmacy service entity that uses direct or indirect remuneration to report certain information to pharmacies or the pharmacies' pharmacy services administration organization; and
• prohibits a pharmacy benefits manager or coordinator from preventing a pharmacist from disclosing cost information to a patient.

Every vote on this bill

Bill text

PHARMACY BENEFITS MANAGER OR COORDINATOR
AMENDMENTS
GENERAL SESSION
STATE OF UTAH
Chief Sponsor: Evan J. Vickers
House Sponsor: 
Paul Ray
LONG TITLE
General Description:
This bill amends the Pharmacy Practice Act.
Highlighted Provisions:
This bill:
▸ defines terms;
▸ requires a pharmacy service entity that uses direct or indirect remuneration to report
certain information to pharmacies or the pharmacies' pharmacy services
administration organization; and
▸ prohibits a pharmacy benefits manager or coordinator from preventing a pharmacist
from disclosing cost information to a patient.
Money Appropriated in this Bill:
None
Other Special Clauses:
None
Utah Code Sections Affected:
ENACTS:
58-17b-626
, Utah Code Annotated 1953
Be it enacted by the Legislature of the state of Utah:
Section 1. Section 
58-17b-626
 is enacted to read:
 58-17b-626.
Direct or indirect remuneration by pharmacy benefits managers --
Disclosure of customer costs.
(1) As used in this section:
(a) "Cost share" means the amount paid by an insured customer under the customer's
health benefit plan.
(b) "Direct or indirect remuneration" means any adjustment in the total compensation:
(i) received by a pharmacy from a pharmacy benefits manager or coordinator for the
sale of a drug, device, or other product or service; and
(ii) that is determined after the sale of the product or service.
(c) "Health benefit plan" means the same as that term is defined in Section 
31A-1-301
.
(d) "Pharmacy services administration organization" means an entity that contracts
with a pharmacy to assist with third-party payer interactions and administrative services related
to third-party payer interactions, including:
(i) contracting with a pharmacy benefits manager or coordinator on behalf of the
pharmacy; and
(ii) managing a pharmacy's claims payments from third-party payers.
(e) "Pharmacy service entity" means:
(i) a pharmacy services administration organization; or
(ii) a pharmacy benefits manager or coordinator.
(f) (i) "Reimbursement report" means a report on the adjustment in total compensation
for a claim.
(ii) "Reimbursement report" does not include a report on adjustments made pursuant to
a pharmacy audit or reprocessing.
(g) "Sale" means a prescription drug claim covered by a health benefit plan.
(2) If a pharmacy service entity engages in direct or indirect remuneration with a
pharmacy, the pharmacy service entity shall make a reimbursement report available to the
pharmacy upon the pharmacy's request.
(3) For the reimbursement report described in Subsection (2), the pharmacy service
entity shall:
(a) include the adjusted compensation amount related to a claim and the reason for the
adjusted compensation; and
(b) provide the reimbursement report:
(i) in accordance with the contract between the pharmacy and the pharmacy service
entity;
(ii) in an electronic format that is easily accessible; and
(iii) within 120 days after the day on which the pharmacy benefits manager or
coordinator receives a report of a sale of a product or service by the pharmacy.
(4) A pharmacy service entity shall, upon a pharmacy's request, provide the pharmacy
with:
(a) the reasons for any adjustments contained in a reimbursement report; and
(b) an explanation of the reasons provided in Subsection (4)(a).
(5) (a) A pharmacy benefits manager or coordinator may not prohibit or penalize the
disclosure by a pharmacist of:
(i) an insured customer's cost share for a covered prescription drug;
(ii) the availability of any therapeutically equivalent alternative medications; or
(iii) alternative methods of paying for the prescription medication, including paying the
cash price, that are less expensive than the cost share of the prescription drug.
(b) Penalties that are prohibited under Subsection (5)(a) include increased utilization
review, reduced payments, and other financial disincentives.
(6) A pharmacy benefits manager or coordinator may not require an insured customer
to pay, for a covered prescription drug, more than the lesser of:
(a) the applicable cost share of the prescription drug being dispensed; or
(b) the retail price of the drug without prescription drug coverage.